Healthcare Provider Details

I. General information

NPI: 1548397482
Provider Name (Legal Business Name): SHARON L. FITELSON D.C. DABCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 CLAYTON RD
RICHMOND HEIGHTS MO
63117-1325
US

IV. Provider business mailing address

7800 CLAYTON RD
RICHMOND HEIGHTS MO
63117-1325
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-2081
  • Fax: 314-644-2309
Mailing address:
  • Phone: 314-644-2081
  • Fax: 314-644-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number004472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: